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« Last post by agate on November 23, 2017, 06:56:43 am »
You'll be said to have hypertension if your blood pressure is 130/80 now. Formerly you weren't called hypertensive unless it was at least 140/90. From MedPage Today, November 21, 2017:
« Last post by agate on November 22, 2017, 08:08:18 pm »
GENERAL DISCUSSION - RESEARCH, NEWS / (Abst.) Age-related MS: Disability ranked by age
« Last post by agate on November 21, 2017, 04:06:39 pm »
Usually when the extent of a person's disability is being discussed, it is correlated with the number of years since MS onset.  This article suggests that a better, more reliable method might be to correlate it with the person's age--since the date of MS onset is often hard to determine.

From Multiple Sclerosis Journal, December 2017:

Age Related Multiple Sclerosis Severity Score: Disability ranked by age

Ali Manouchehrinia, Helga Westerlind, Elaine Kingwell, Feng Zhu, Robert Carruthers, Ryan Ramanujam, Maria Ban, Anna Glaser, Stephen Sawcer, Helen Tremlett, Jan Hillert


The Multiple Sclerosis Severity Score (MSSS) is obtained by normalising the Expanded Disability Status Scale (EDSS) score for disease duration and has been a valuable tool in cross-sectional studies.


To assess whether use of age rather than the inherently ambiguous disease duration was a feasible approach.


We pooled disability data from three population-based cohorts and developed an Age Related Multiple Sclerosis Severity (ARMSS) score by ranking EDSS scores based on the patient’s age at the time of assessment. We established the power to detect a difference between groups afforded by the ARMSS score and assessed its relative consistency over time.


The study population included 26058 patients from Sweden (n = 11846), Canada (n = 6179) and the United Kingdom (n = 8033). There was a moderate correlation between EDSS and disease duration (r = 0.46, 95% confidence interval (CI): 0.45–0.47) and between EDSS and age (r = 0.44, 95% CI: 0.43–0.45). The ARMSS scores showed comparable power to detect disability differences between groups to the updated and original MSSS.


Since age is typically unbiased and readily obtained, and the ARMSS and MSSS were comparable, the ARMSS may provide a more versatile tool and could minimise study biases and loss of statistical power caused by inaccurate or missing onset dates.
For years we've been hearing that there are roughly 400,000 cases of MS in the US. The National MS Society revised its guidelines for a prevalence study and came up with new results--which are considered preliminary but were presented at the recent ECTRIMS conference.  Instead of 400,000 the figure is 947,000. This probably doesn't represent an increase in the number of MS cases. The difference is largely due to a change in the way the tally was done.
From PubMed, November 18, 2017:

Nat Rev Neurol. 2017 Nov 17.

Achievements and obstacles of remyelinating therapies in multiple sclerosis

Stangel M1, Kuhlmann T2, Matthews PM3, Kilpatrick TJ4.

Author information
Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Institute of Neuropathology, University Hospital Münster, Pottkamp 2, 48149 Münster, Germany.
Division of Brain Sciences, Department of Medicine, and UK Dementia Research Institute, Imperial College London, Burlington Danes, Hammersmith Hospital, DuCane Road, London W12 0NN, UK.
Department of Anatomy and Neuroscience and Melbourne Neuroscience Institute, University of Melbourne, 30 Royal Parade, Parkville, Victoria 3010, Australia.

Remyelination in the CNS is the natural process of damage repair in demyelinating diseases such as multiple sclerosis (MS). However, remyelination becomes inadequate in many people with MS, which results in axonal degeneration and clinical disability. Enhancement of remyelination is a logical therapeutic goal; nevertheless, all currently licensed therapies for MS are immunomodulatory and do not support remyelination directly.

Several molecular pathways have been identified as potential therapeutic targets to induce remyelination, and some of these have now been assessed in proof-of-concept clinical trials. However, trial design faces several obstacles: optimal clinical or paraclinical outcome measures to assess remyelination remain ill-defined, and identification of the ideal timing of therapy is also a crucial issue. In addition, realistic expectations are needed concerning the probable benefits of such therapies.

Nevertheless, approaches that enhance remyelination are likely to be protective for axons and so could prevent long-term neurodegeneration. Future MS treatment paradigms, therefore, are likely to comprise a combinatorial approach that involves both immunomodulatory and regenerative treatments.
TREATMENTS / (Abst.) High-dose biotin as treatment for progressive MS
« Last post by agate on November 17, 2017, 09:19:07 pm »
Disappointing results here but it's a small study.

From PubMed, November 17, 2017:

Mult Scler Relat Disord. 2017 Nov;18:141-143.

High dose biotin as treatment for progressive multiple sclerosis

Birnbaum G1, Stulc J2.

Author information
MS Treatment and Research Center, Minneapolis Clinic of Neurology, 4225 Golden Valley Road, Golden Valley, MN 55422, USA. Electronic address:
MS Treatment and Research Center, Minneapolis Clinic of Neurology, 4225 Golden Valley Road, Golden Valley, MN 55422, USA.


Published data suggested high dose biotin improved patients with progressive MS. We wished to determine benefits and side effects of administering daily high dose biotin to patients with progressive multiple sclerosis in a large MS specialty clinic.


Forty-three patients with progressive multiple scleroses were prescribed pharmaceutical grade biotin as a single daily dose of 300mg/day. Brain MRIs were performed at baseline and after one year on biotin. Quantitative neurologic exams (EDSS) and blood work monitoring for biotin toxicity were performed at baseline and every three months thereafter.


High dose biotin was safe, and well tolerated, with no evidence of toxicity on blood work and no new lesions on brain MRIs. None of the patients' EDSS scores improved. One-third of patients (38-43%) worsened, most often with increased lower extremity weakness, worsened balance, and more falling, with two patients worsening sufficiently to increase their EDSS scores by 0.5. Several worsened patients improved after stopping biotin.


High dose biotin was safe and well tolerated, but of no demonstrable long-term benefit. More than one-third of patients worsened while on biotin, most likely due to their disease, but in some patients also possibly due to the inability of their injured central nervous systems to respond to the increased metabolic demands induced by biotin.
GENERAL DISCUSSION - RESEARCH, NEWS / (Abst.) Comparing the efficacy of DMTs in MS
« Last post by agate on November 17, 2017, 09:11:56 pm »
From PubMed, November 17, 2017:

Mult Scler Relat Disord. 2017 Nov;18:109-116.

Comparing the efficacy of disease-modifying therapies in multiple sclerosis

Mitsikostas DD1, Goodin DS2.

Author information
National and Kapodistrian University of Athens, 1st Department of Neurology, Aeginition Hospital, Athens, Greece.
University of California, San Francisco, Department of Neurology, 505 Parnassus Ave, Suite M-794, San Francisco, CA 94143-0114, USA.

Establishing the relative efficacy and safety of the different disease modifying therapies (DMTs) in multiple sclerosis (MS) is critical to the choice of agent that clinicians recommend for individual MS patients.

The best evidence for the relative efficacy of the different DMTs comes from head-to-head randomized clinical trials (RCTs). Understanding that outcome-measures with the best established validity are the relapse rate and the actual (not the "confirmed") change in the extended disability status scale (EDSS), we conclude from these head-to-head RCTs that interferon-beta (IFNβ) given subcutaneously multiple times per week (either IFNβ-1b or IFNβ-1a) and glatiramer acetate (GA) are about equivalent in terms of efficacy and that both of these agents, as well as many of the other DMTs, are superior to weekly intramuscular IFNβ-1a.

Nevertheless, as ever-newer agents with novel mechanisms of action are brought to the marketplace, such direct head-to-head trials are becoming increasingly impractical, raising the need for alternative methods to draw reasonable inferences from less rigorous clinical data.

One possible approach to judging comparative efficacy is to make comparisons across clinical trials using the complimentary analytic methods of calculating both the relative risk/rate and the absolute risk/rate reductions. A consideration and application of this analytic approach is undertaken here. It is only with an understanding of the safety and efficacy of the different agents that we can select, together with the patient, the right agent for the right person.
« Last post by agate on November 16, 2017, 04:11:14 pm »
Presented at the ECTRIMS/ACTRIMS conference (Paris, October 2017):

The effect of disease-modifying treatments on conversion to secondary progressive multiple sclerosis

J.W.L. Brown1,2,3, A. Coles1, D. Horakova4, E. Havrdova4, M. Trojano5, G. Izquierdo6, A. Prat7,8, M. Girard7,8, R. Hupperts9, V. Van Pesch10, D. Ferraro11, R. Alroughani12, R. Bergamaschi13, E. Pucci14, G. Iuliano15, J. Lechner-Scott16,17, T. Spelman18,19, V. Jokubaitis18,19, C. Ramo-Tello20, D. Spitaleri21, F. Granella22, C. Solaro23, R. Ampapa24, N. Deri25, P. McCombe26,27, T. Petersen28, B. Van Wijmeersch29, J. Prevost30, J.L. Sanchez-Menoyo31, A. Soysal32, M. Barnett33, F. Moore34, C. Rice35,36, N. Scolding35,36, A. Wilkins35, C. McGuigan37,38, M. Hutchinson37,38, T. Ziemssen39, O. Pearson40, K. Harding41, P. Duquette7,8, A. Lugaresi42,43,44, P. Grammond45, F. Grand'Maison46, M. Terzi47, V. Shaygannejad48, P. Sola49, H. Butzkueven18,19,50, T. Kalincik3,18,19, N. Robsertson41,51

1Department of Clinical Neurosciences, University of Cambridge, Cambridge, 2NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, United Kingdom, 3University of Melbourne, CORe Unit, Department of Medicine, Melbourne, VIC, Australia, 4Department of Clinical Neurosciences, Charles University and General University in Prague, Prague, Czech Republic, 5Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy, 6Hospital Universitario Virgen Macarena, Sevilla, Spain, 7Hopital Notre Dame, 8CHUM and Universite de Montreal, Montreal, QC, Canada, 9Zuyderland Medical Center, Sittard-Geleen, The Netherlands, 10Cliniques Universitaires Saint-Luc, Brussels, Belgium, 11Azienda Ospedaliera Universitaria, Modena, Italy, 12Amiri Hospital, Kuwait City, Kuwait, 13C. Mondino National Neurological Institute, Pavia, 14Azienda Sanitaria Unica Regionale Marche, Macerata, 15Ospedali Riuniti di Salerno, Salerno, Italy, 16School of Medicine and Public Health, University Newcastle, 17Department of Neurology, John Hunter Hospital, Newcastle, NSW, 18Department of Medicine, 19Department of Neurology, University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia, 20Hospital Germans Trias i Pujol, Badalona, Spain, 21Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avvelino, 22University of Parma, Parma, 23Ospedale P. A. Micone, Genova, Italy, 24Nemocnice Jihlava, Jihlava, Czech Republic, 25Hospital Fernandez, Capital Federal, Argentina, 26University of Queensland, 27Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia, 28Kommunehospitalet, Arhus, Denmark, 29Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium, 30CSSS Saint-Jérôme, Saint-Jerome, QC, Canada, 31Hospital de Galdakao-Usansolo, San Sebastian, Spain, 32Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey, 33Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia, 34Jewish General Hospital, Montreal, QC, Canada, 35Department of Neurology, Southmead Hospital, 36Department of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom, 37School of Medicine and Medical Sciences, University College Dublin, 38St Vincent's University Hospital, Dublin, Ireland, 39Center of Clinical Neuroscience, Department of Neurology, MS Center Dresden, University of Dresden, Dresden, Germany, 40Abertawe Bro, Morgannwg University Local Health Board, Swansea, 41Institute for Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom, 42Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti, 43Department of Biomedical and Neuromotor Sciences, University of Bologna, University of Bologna, 44IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy, 45CISSS Chaudière-Appalache, Levis, 46Neuro Rive-Sud, Montreal, QC, Canada, 4719 Mayis University, Medical Faculty, Samsun, Turkey, 48Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran, 49Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy, 50Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia, 51University Hospital of Wales, Cardiff, United Kingdom


 Licensed immunotherapies do not slow secondary progressive multiple sclerosis (SPMS) once it has begun. The extent to which SPMS reflects early inflammation - and whether conversion to SPMS might be modified by immunomodulatory disease-modifying therapies (DMTs) during the relapsing-remitting (RR) phase - remains unclear.


We examined whether DMTs delay or reduce conversion from RRMS to SPMS using an objective definition of SPMS (Lorscheider 2016, Brain).


Patients from MSBase with RRMS treated with a single DMT (injectables (interferons/glatiramer acetate, n=240), fingolimod (n=109), natalizumab (n=93) or alemtuzumab (n=44) with at least 4 years' on-treatment follow-up were each propensity matched to 1) untreated patients with RRMS from a historical cohort (n=622, mean follow-up 9.2 years); then 2) different DMT groups. Patients were matched on gender plus baseline age, annualised-relapse rate, EDSS score and disease duration.

Weighted conditional proportional hazards models adjusted for EDSS frequency with pair-wise censoring compared the proportions of each group free from conversion to SPMS. Lower efficacy drug groups may have been biased towards milder disease through excluding patients with multiple DMTs (such as treatment escalators). We therefore limited the injectables group to patients followed-up before higher-efficacy drugs (for treatment escalation) became available in 2006.


Injectables (HR 0.31, p< 0.001, median censored on-treatment follow-up 7.9 years), fingolimod (HR 0.23, p< 0.001, follow-up 4.6 years), natalizumab (HR 0.50, p=0.001, follow-up 4.9 years) and alemtuzumab (HR 0.60, p=0.01, follow-up 7.2 years) reduced the hazard of conversion to SPMS compared to different groups of matched untreated patients in a series of pairwise analyses.

When matching between the treated cohorts there was no significant difference in conversion to SPMS between alemtuzumab and natalizumab patients (p=0.2). Alemtuzumab and natalizumab were therefore combined as 'high-efficacy therapies' (n=118) and matched and compared to the injectables group (n=236). High-efficacy therapies conferred greater protection against conversion to SPMS than injectables (HR 0.65, p=0.038, follow-up 5.7 years).


 SPMS is - at least partially - a consequence of early inflammation. The risk of conversion from RRMS to SPMS is modifiable over 5 years with existing DMTs, more so with high-efficacy therapies, alemtuzumab and natalizumab.


William Brown reports travel expenses for attending conferences or teaching courses from Novartis, Biogen, and Sanofi Genzyme.
Alasdair Coles reports personal fees and honoraria, consulting fees, and travel expenses for attending meetings from Genzyme; AC has a patent on the dose regime of alemtuzumab as a treatment of multiple sclerosis pending.
Dana Horakova received speaker honoraria and consulting fees from Biogen, Merck, Teva and Novartis, as well as support for research activities from Biogen and research grants from Charles University in Prague (PRVOUK-P26/LF1/4 and Czech Ministry of Health (NT13237-4/2012).
Eva Havrdova received speaker honoraria and consultant fees from Actelion, Biogen, Celgene, Merck, Novartis, Roche, Sanofi and Teva, and support for research activities from Czech Ministry of Education, project Progres Q27/LF1.
Maria Trojano received speaker honoraria from Biogen-Idec, Bayer-Schering, Sanofi Aventis, Merck, Teva , Novartis and Almirall; has received research grants for her Institution from Biogen-Idec, Merck, and Novartis.
Guillermo Izquierdo received speaking honoraria from Biogen, Novartis, Sanofi, Merck and Teva.
Alexandre Prat did not declare any competing interests.
Marc Girard received consulting fees from Teva Canada Innovation, Biogen, Novartis and Genzyme Sanofi; lecture payments from Teva Canada Innovation, Novartis and EMD. He has also received a research grant from Canadian Institutes of Health Research.
Raymond Hupperts received honoraria as consultant on scientific advisory boards from Merck, Biogen, Genzyme-Sanofi and Teva, research funding from Merck and Biogen, and speaker honoraria from Sanofi-Genzyme and Novartis.
Vincent Van Pesch received travel grants from Biogen, Bayer Schering, Genzyme, Merck, Teva and Novartis Pharma. His institution receives honoraria for consultancy and lectures from Biogen, Bayer Schering, Genzyme, Merck, Roche, Teva and Novartis Pharma as well as research grants from Novartis Pharma and Bayer Schering.
Diana Ferraro received travel grants and/or speaker honoraria from Merck, TEVA, Novartis, Biogen and Sanofi-Genzyme.
Raed Alroughani received honororia from Biologix, Biogen, Bayer, Genpharm, Genzyme, Merck, GSK and Novartis, and served on advisory board for Biologix, Biogen, Bayer, Genpharm, Genzyme, Novartis, Genzyme, Merck and Novartis.
Roberto Bergamaschi received speaker honoraria from Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva; research grants from Bayer Schering, Biogen, Merck , Novartis, Sanofi-Aventis, Teva; congress and travel/accommodation expense compensations by Almirall, Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva.
Eugenio Pucci served on scientific advisory boards for Merck , Genzyme and Biogen; he has received honoraria and travel grants from Sanofi Aventis, UCB, Lundbeck, Novartis, Bayer Schering, Biogen, Merck , Genzyme and Teva; he has received travel grants and equipment from "Associazione Marchigiana Sclerosi Multipla e altre malattie neurologiche".
Gerardo Iuliano had travel/accommodations/meeting expenses funded by Bayer Schering, Biogen, Merck , Novartis, Sanofi Aventis, and Teva.
Jeannette Lechner-Scott accepted travel compensation from Novartis, Biogen and Merck. Her institution receives the honoraria for talks and advisory board commitment from Bayer Health Care, Biogen, Genzyme Sanofi, Merck, Novartis and Teva, has been involved in clinical trials with Biogen, Novartis and Teva.
Tim Spelman received honoraria for consultancy, funding for travel and compensation for serving on scientific advisory boards from Biogen and speaker honoraria from Novartis.
Vilija Jokubaitis received conference travel support from Teva, Novartis and Merck, and speaker honoraria from Biogen.
Cristina Ramo-Tello received research funding, compensation for travel or speaker honoraria from Biogen, Novartis, Genzyme and Almirall.
Daniele Spitaleri received honoraria as a consultant on scientific advisory boards by Bayer-Schering, Novartis and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva and Merck.
Franco Granella served on scientific advisory boards for Biogen Idec, Novartis and Sanofi Aventis and received funding for travel and speaker honoraria from Biogen Idec, Merck , and Almirall.
Claudio Solaro did not declare any competing interests.
Radek Ampapa received conference travel support from Novartis, Teva, Biogen, Bayer and Merck and has participated in a clinical trials by Biogen, Novartis, Teva and Actelion.
Norma Deri received funding from Bayer, Merck , Biogen, Genzyme and Novartis.
Pamela McCombe did not declare any competing interests.
Thor Petersen received funding or speaker honoraria from Biogen, Merck , Novartis, Bayer Schering, Sanofi-Aventis, Roche, and Genzyme.
Bart Van Wijmeersch did not declare any competing interests.
Julie Prevost accepted travel compensation from Novartis, Biogen, Genzyme, Teva, and speaking honoraria from Biogen, Novartis, Genzyme and Teva.
Jose Luis Sanchez-Menoyo accepted travel compensation from Novartis and Biogen, speaking honoraria from Biogen, Novartis, Sanofi, Merck , Almirall, Bayer and Teva and has participated in a clinical trial by Biogen.
Aysun Soysal did not declare any competing interests.
Michael Barnett served on scientific advisory boards for Biogen, Novartis and Genzyme and has received conference travel support from Biogen and Novartis. He serves on steering committees for trials conducted by Novartis. His institution has received research support from Biogen, Merck and Novartis.
Fraser Moore participated in clinical trials sponsored by EMD and Novartis.
Claire Rice reports no competing interests.
Neil Scolding reports grants from Biogen, Sanofi Genzyme, Merck Serono, Teva, and Novartis.
Alastair Wilkins declares no competing interests.
Christopher McGuigan has received grants and personal fees from Biogen, Novartis, Genzyme, Merck and Roche.
Michael Hutchinson served on a medical advisory board for the CONFIRM study (BG00012) for Biogen; has received speaker´s honoraria from Novartis, Biogen, and Bayer Schering; and receives research support from Dystonia Ireland, the Health Research Board of Ireland, and the European Dystonia Foundation.
Tjalf Ziemssen reports grants from Novartis; grants and personal fees from Bayer, Biogen, Teva, Genzyme, and Novartis; and personal fees from Merck, Almirall, GlaxoSmithKline, and Roche.
Owen Pearson declares no competing interests.
Katharine Harding has received one research grant from Novartis.
Pierre Duquette served on editorial boards and has been supported to attend meetings by EMD, Biogen, Novartis, Genzyme, and TEVA Neuroscience. He holds grants from the CIHR and the MS Society of Canada and has received funding for investigator-initiated trials from Biogen, Novartis, and Genzyme.
Alessandra Lugaresi is a Bayer, Biogen, Genzyme, Merck Advisory Board Member. She received travel grants and honoraria from Bayer, Biogen, Merck, Novartis, Sanofi, Teva and Fondazione Italiana Sclerosi Multipla (FISM). Her institution received research grants from Bayer, Biogen, Merck, Novartis, Sanofi , Teva and Fondazione Italiana Sclerosi Multipla (FISM).
Pierre Grammond is a Merck, Novartis, Teva-neuroscience, Biogen and Genzyme advisory board member, consultant for Merck , received payments for lectures by Merck , Teva-Neuroscience and Canadian Multiple sclerosis society, and received grants for travel from Teva-Neuroscience and Novartis.
Francois Grand´Maison received honoraria or research funding from Biogen, Genzyme, Novartis, Teva Neurosciences, Mitsubishi and ONO Pharmaceuticals.
Murat Terzi received travel grants from Merck , Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis.
Vahid Shaygannejad did not declare any competing interests.
Patrizia Sola served on scientific advisory boards for Biogen Idec and TEVA, she has received funding for travel and speaker honoraria from Biogen Idec, Merck , Teva, Sanofi Genzyme, Novartis and Bayer and research grants for her Institution from Bayer, Biogen, Merck , Novartis, Sanofi, Teva.
Helmut Butzkueven served on scientific advisory boards for Biogen, Novartis and Sanofi-Aventis and has received conference travel support from Novartis, Biogen and Sanofi Aventis. He serves on steering committees for trials conducted by Biogen and Novartis, and has received research support from Merck , Novartis and Biogen.
Tomas Kalincik served on scientific advisory boards for Roche, Genzyme-Sanofi, Novartis, Merck and Biogen, steering committee for Brain Atrophy Initiative by Genzyme, received conference travel support and/or speaker honoraria from WebMD Global, Novartis, Biogen, Genzyme-Sanofi, Teva, BioCSL and Merck and received research support from Biogen.
Neil Robertson reports personal and institutional research grant from Genzyme and Novartis.

Metabolism of the essential amino acid methionine seems to be disrupted in MS, especially in progressive forms, according to this.

From MedPage Today, November 15, 2017:
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